Cardio Pulmonary

UNIT 7 CARDIO PULMONARY Resuscitation (CPR) and

Recovery Position
RESUSCITATION (CPR) AND
RECOVERY POSITION
Structure
7.0 Introduction
7.1 Objectives
7.2 Assessing a Victim for CPR/Recovery Position
7.3 Cardiopulmonary Resuscitation (CPR)
7.3.1 Concept and Purpose
7.3.2 Procedure
7.3.3 Safety and Precautions

7.4 Recovery Position

7.4.1 Concept and Purposes
7.4.2 Procedure
7.4.3 Safety and Precautions
7.5 Let Us Sum Up
7.6 Key Words
7.7 Answers to Check Your Progress
7.8 Activities
7.9 References

7.0 INTRODUCTION
In the theory unit on “Understanding Human Body” which is Unit 2 of
Block 1 of Theory course, you have learnt about how our breathing and
circulatory systems function in coordination with one another to provide
oxygen, glucose and other nutrients to various organs of our body. If any
of these systems stop working, our brain stops functioning within a few
minutes. The commonest condition where it happens is sudden cardiac
arrest. However, both these systems can be revived either by CPR or by
placing the victim in recovery position.
You have a little idea about these procedures since we have discussed
about them in Theory Block 2 , Unit 1 on “Recognizing Emergencies” and
Unit 3 of the same Block on ‘‘CPR and AED’’.
In this unit you will learn to assess a victim for giving CPR and placing
him/her in recovery position followed by acquiring the skills for performing
CPR and recovery position.

7.1 OBJECTIVES
After completion of this unit, you will be able to:
l assess a victim for recovery position and CPR;
l acquire skills in performing CPR; and
l demonstrate skills by placing a victim in recovery position. 113
Practical Manual-I
7.2 ASSESSING A VICTIM FOR CPR/
RECOVERY POSITION
Before approaching a victim you have to ensure that the environment is
safe for you and the victim. We have discussed this part in detail in
Unit 1 (Recognizing emergencies) and Unit 3 (CPR and AED) of Block 2
of Theory course and Unit 1 of this Practical Block. After this the most
important thing is to assess whether the victim needs to be placed in
recovery position or he/she needs CPR. In this section, you will learn the
skills for this assessment and for performing CPR or placing the victim in
Recovery Position.
Purpose
The main purpose of assessing the victim is to conduct assessment and
find out which procedure must be started to resuscitate the victim in
emergency.
Articles required
For this activity you need to have a volunteer. However he/she should be
explained that they would have to be placed in a specific position by
changing the posture. You can also take a manikin instead.
Procedure
Step 1 Ask the volunteer to act as victim. Ask him/her to lie down
on their back.
Skills : The volunteer should lie down comfortably on his back
with his hand on the side of his/her body and both the
feet straight.
Step 2 Conduct assessment as per the flow-diagram given below:

Scene Safety

Call for help

Is the person responding?

Responding Not responding

Breathing with pulse Breathing with pulse Not breathing/No pulse

Start CPR
Check for DOTS  Place in recovery


position
Use AED

Provide first aid 

When revived/
Becomes Conscious
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Step 3 Tap the person on one of his shoulders and speak loudly, Cardio Pulmonary
“Hello, Are you Okay?” Resuscitation (CPR) and
Recovery Position

Skills : Tapping of shoulder and speaking, “ Hello, Are you Okay?”

should be done simultaneously. This is done to check
response. If the victim is an infant( age 0-1 year), you should
tap on any one of the heels of his/her foot.

Step 4 If the person does not respond, check for pulse and breathing.

Skills : Check pulse by observing carotid or radial pulse. The

breathing should be checked by observing the chest rise
with each effort of breathing in. Gasping should be
considered as absence of breathing.

Step 5 If the person does not respond but is breathing and has
pulse, place him/her in Recovery Position.

Step 6 If a victim is not responding and not breathing with no pulse,

CPR should be started immediately.

Skills : The procedure for CPR is discussed in Section 7.3 and

the procedure for Recovery Position is discussed in
Section 7.4 of this Unit.

Step 7 Continue the procedure till victim is revived.

Thus, by assessing a victim for responsiveness and breathing you can

decide what first aid care is to be provided to save his/her life.

7.3 CARDIOPULMONARY RESUSCITATION

(CPR)
In the previous section we learnt how to assess the victim in emergency
and decide the next step of action i.e. whether to give CPR or place the
person in recovery position. In this section, we will learn about CPR and
procedure of giving CPR. So, lets begin.

7.3.1 Concept and Purpose

Concept

Cardiopulmonary Resuscitation (CPR) simply means:

Cardio – heart

Pulmonary- related to lungs

Resuscitation- revival

It is the process of revival of the functions of heart and lungs once they
have stopped. This is done by an alternating process of compressing the
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Practical Manual-I chest of the person and giving him/her artificial breathing in a cycle of 30
chest compressions and 2 artificial rescue breaths. This is an emergency
procedure which is repeated till the functions of heart and lungs are
restored (Fig 7.1).

We have discussed the concept of CPR in detail in Theory Unit 3 of

Block 2 of Theory course.

Fig. 7.1: Giving CPR

Purpose of CPR

CPR is performed in sudden cardiac arrest, a dangerous situation where

our heart can not pump out the blood to our body. Sudden cardiac arrest
can occur in various situations like  electric shock, heart disease, severe
blood loss, overdose of some drugs, allergic reaction, drowning and in
poisonous snake bites. The lack of blood and oxygen to brain makes the
person unconscious, breathing stops and death can occur within minutes.

In CPR we provide chest compressions alternating with rescue breaths in

a ratio of 30 chest compression to 2 rescue breaths. This provides blood
as well as oxygen to our brain to sustain life for some time. During this
time we alert and call the emergency response system/emergency medical
services to provide advanced care. As you have learnt in Theory Unit 3
of Block 2 on CPR & AED, the most effective treatment of sudden
cardiac arrest is use of AED. But it may not be immediately available and
CPR buys time for victim to sustain blood circulation and breathing till
AED or help or ambulance arrives.

7.3.2 Procedure
When giving CPR the procedure is as follows:

Articles required

The following articles/equipments are required for learning various skills in

performing effective CPR

1. An adult CPR manikin

2. An infant CPR manikin

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Steps of Procedure for giving CPR Cardio Pulmonary
Resuscitation (CPR) and
Step 1 As the scenario is such that the person is not responding and Recovery Position
not breathing,
You will activate Emergency Medical Services (ambulance) and
also ask for AED. Meanwhile you will start CPR.
Skills : Emergency Medical Services are different in each country.
In our country, it is calling an Ambulance or any
hospital staff from the nearby hospital. Also the phone
no of ambulance varies from state to state in India. The
various phone numbers and helpline numbers have been
provided in the Appendix 1 of Unit 1 of Block 1 of
theory course. You can also update it.
Step 2 Sit on your knees on the side of the manikin.
Step 3 Place the heel of your dominant hand on the lower half of the
breast bone (Fig. 7.2).
point at the junction of
collar bone
point to give
compressions on
breast bone
lower halfside

point where ribs meets

ribs

Fig. 7.2: Location for giving Chest Compressions

Skills : For finding out where to place the hands on the chest
while giving compressions, you can make out the centre
of chest and place your hands below this centre point to
give chest compressions. This roughly comes in the centre
point of line drawn between two nipples on the lower
side of breast bone.

Step 4 Place your other hand over this hand and lock the fingers
(Fig. 7.3).

Fig. 7.3: Locking the fingers over the location

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Practical Manual-I Step 5 Give 30 compressions fast and deep using the pressure of
your body from your shoulders at the rate of 100-120 per
minute(Fig. 7.4). Push at about 2 inches in adults and children
(1- 8 years) and at least 1.5 inches in infants( 0-1yr). So,
Push hard and Push Fast.

Fig. 7.4: Giving Chest Compression

Skills: The compression technique is similar in children

(1-8 years of age). You can use one or both hands
depending upon the age and built of the child. For
infants (New born and upto one year of age) you
should place index and middle fingers on the breast
bone just below the nipple line as discussed in Unit 3
of Theory Block 2.
Step 6 Verify the correctness of your compressions by the “ click”
sound during each Compression.
Skills: By simply following the above steps, chest compressions
are given. This is the technique for Hands –only CPR in
which only chest compressions without rescue breaths are
provided till help arrives or AED is made available or
some other trained bystander comes to help you. Follow
this if you are not comfortable doing resucue breaths. It
is a good method and helps to maintain the victim till
the help comes. But it is always better to give CPR
with rescue breaths. So, try to initiate CPR with Chest
compressions and rescues breaths in all situations.
Step 7 After 30 chest compressions, open the mouth of the manikin
and observe for any foreign body in the nose or mouth. If
you find anything, carefully take it out but avoid blind sweep
(Fig. 7.5). The detailed procedure for sweeping has been
discussed in Unit 4 of Block 2 of this Practical Course.

Fig. 7.5: Open airway by sweeping out foreign matter

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Step 8 Open the airways by “Head tilt and Chin lift technique” Cardio Pulmonary
(Fig 7.6). For victim with Head and Spinal injuries, assess and Resuscitation (CPR) and
Recovery Position
use “Jaw thrust” technique discussed in Unit 1 of Practical
Block 2 and Unit 2 of Theory Block 3.
Skills: Apply firm, backward pressure on the forehead ( head
tilt) while lifting the chin upward (Chin lift). This will
tilt the head back and move the jaw forward.

Fig. 7.6: Head Tilt and Chin Lift

Step 9 Place the back of one hand on the forehead of the victim and block
the nose by pinching it with your thumb and index finger.
Skills: Avoid pressing the soft tissues with your fingers as it can
obstruct the airways.
Step 10 Place the fingers of the other hand under the bony part of the
chin. The thumb should be placed on the upper part of the
chin to open the mouth slightly.
Step 11 Place a barrier (face mask/handkerchief/chunni or dupatta) over
the mouth of the a victim as per your choice or if the victim
is stranger.
Skills: This will help to avoid cross-infection.
Step 12 Take a deep breath.
Step 13 Encircle the mouth of the victim by your mouth, making a tight
seal (Fig. 7.7).
Step 14 Blow the air into the mouth of the victim for one second and
check the rise of chest (Fig. 7.7).
Skills: In case of children and infants, the rescue breaths need not
be too forceful. Moreover, in infants the seal of your mouth
should cover both nose and mouth.

Fig. 7.7: Giving Rescue Breaths 119

Practical Manual-I Step 15 If you can not see the chest rise, again position victim’s head
by jaw thrust or head tilt and chin lift technique discussed
earlier and make a good seal between the mouth of victim
and your mouth. Blow the air again into the mouth of the
victim and keep observing the rise of chest (Fig. 7.8).

Fig. 7.8: Observe Rise and Fall of Chest

Step 16 Repeat the continuous cycles of 30 chest compressions and 2

rescue breaths.
Skills: When other trained person is available, one can give
chest compression and the other person can give rescue
breaths. Both the persons should switch their roles after
every 2 minutes (or 5 cycles) (Fig. 7.9). For children
below 8 years and infants, with 2 rescuers the ratio of
compression and breaths is 15:2.

Fig. 7.9: Two rescuer CPR

Step 17 If an AED becomes available, turn it on and follow the AED’s
voice instructions.
Skills: If AED prompts you to do CPR, continue cycles of 30
chest compressions and 2 rescue breaths. If AED prompts
you to stop CPR, assess the victim for response and
breathing and follow the flow diagram in Section 7.2.
(We have discussed about AED in detail in Unit 3 of
theory block 2 on CPR and AED and in the next Unit
of this Block on AED)
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Step 18 If AED is not available, continue the cycles of 30 chest Cardio Pulmonary
compressions and 2 rescue breaths. Resuscitation (CPR) and
Recovery Position
Remember:
CPR has to be continued till:
l the victim starts responding and/or breathing
l specialized medical help arrives
l Someone (a trained personnel) relieves you
l AED becomes available.

Step 19 Transport as soon as medical help arrives. Record and Report

thereafter as required.

7.3.3 Safety and Precautions

The safety precautions to be followed are as follows:
1. Chest compressions:
l Follow the recommended position of hands. It will prevent
fracture of ribs and provide desired effective chest compressions.
l There should not be any movement of your wrists when giving
compressions.
l Elbows should be straight.
l The contact with chest wall should not be lost at any time.
l Allow complete chest recoil (coming of chest in its original
position) after each compression.
l The rate should be at least 100-120/minute.
l You should keep on counting from 1…. 30 to make the
compressions synchronous.
l Minimize any interruptions between the compressions.
2. Rescue breaths :
l If chest rise is not visible, rescue breaths are not effective.
It means that either the mouth to mouth seal is not proper or
rescue breaths are not enough or forceful or the airway is not
patent.
l Avoid pressing the soft tissues of nose with your fingers as it
can obstruct the airways.
l Take a deep breath before giving rescue breaths. Never blow
twice – one after the another without taking a deep breath in
between as the oxygen concentration will be less.
l Each breath should be given over 1 second.
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Practical Manual-I
Check Your Progress 1
1. True or False:
a. The two rescue breaths must be given together.
True/False ……
b. Chest rise shows that the rescue breaths are effective.
True/False ……
c. Chest compressions alone can be effective in
reviving the person in certain cases. True/False ……
d. Sweeping action can help to clear the airway.
True/False ……
e. Apply the force from the shoulders in CPR.
True/False ……

Thus, in this section we talked about CPR and procedure for performing
CPR. We will now proceed towards discussion on Recovery Position.

7.4 RECOVERY POSITION

In this section we will highlight the role of Recovery Position and purpose
and procedure for putting a victim in recovery position.
7.4.1 Concept and Purpose
Concept
In an unresponsive person, the tone of the muscles is lost making them
flabby. Similarly the tongue, which is attached to the lower jaw, also gets
relaxed and flabby. It falls backwards and obstructs the airway. You have
already read in the previous section that in a non-responsive person, the
airway can be opened and maintained using “Head tilt and chin lift”
technique.
However, in a nonresponsive person who is breathing “Head tilt and chin
lift” technique has no use and also the airway in this situation can be
obstructed by secretions and any fluids/blood collected in the oral cavity.
These secretions can cause choking in the victim. So, in order to remove
these secretions the victim is placed in such a position where the body is
on the side (side lying position) and upper leg is flexed and lower leg is
extended with mouth open. Hence, the secretions then can drain out from
the mouth to the outside (Fig. 7.10).

Fig. 7.10: Recovery Position

Purpose of recovery position

Recovery position helps to maintain breathing in a non-responsive but breathing
victim having pulse by prevention of choking which occurs due to tongue of the
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victim which falls back in the airways due to loss of tone or due to secretions/ Cardio Pulmonary
fluids and blood collected in the oral cavity. Resuscitation (CPR) and
Recovery Position
7.4.2 Procedure
The procedure for recovery position is as follows:
Articles required
For this activity you need to have a volunteer to act as victim. However,
he/she should be explained that they will have to be placed in a specific
position by changing the posture.
Procedure
Step 1 Ask the volunteer to act as victim. Ask him/her to lie down
on his back
Step 2 Tap the person on one of his shoulders and speak loudly,
“Hello, Are you Okay?” If the victim is an infant (age 0-1
year), you should tap on any of the heels of his/her foot.
Skills: This helps to check response.
Step 3 If the person does not respond, check for the breathing. If the
breathing is present, place the victim in recovery position.
Step 4 Sit on your knees on the side of the victim.
Step 5 Hold the person’s hand near you and raise it straight along
his/her head (Fig. 7.11).

Fig. 7.11: Hold the person’s hand and raise it straight

Step 6 Take the person’s other hand, fold it at the elbow and place
the back of the hand against the cheek on your side
(Fig 7.12).

Fig. 7.12: Keeping the other hand under the cheek on your side 123
Practical Manual-I Step 7 Hold the leg of the person (on opposite side to you) and
raise it by folding on the hip Joint (Fig. 7.13).

Fig. 7.13: Position to hold the leg

Step 8 Hold the person from hip and the raised leg and roll over
towards you.
Step 9 The person now should rest in a lateral or side-lying position
supported by his elbow and knee (Fig. 7.14).

Fig. 7.14: Recovery Position

Skills: These steps should be done smoothly and swiftly.

Step 10 Record and report.

7.4.3 Safety and Precautions

A victim will only be placed in recovery position if he/she is not
responding but has pulse and is breathing. If a victim is not responding
and not breathing, immediate CPR should be started.
In the recovery position, the victim needs to be continuously monitored as
he/she can switch over from one state to another i. e. from non-
responding to responding or breathing to not breathing and vice versa.
Accordingly, we have to provide the first aid care to him/her as discussed
in section 7.2.
Check Your Progress 2
1. Define Recovery Position.
........................................................................................................
................................................................................................. ….
2. List the indications for giving Recovery Position.
........................................................................................................
........................................................................................................
........................................................................................................
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 Cardio Pulmonary
7.5 LET US SUM UP Resuscitation (CPR) and
Recovery Position
Hence, in this practical we learnt about procedure for giving CPR and
placing the victim in Recovery Position. So, whenever need arises you as
a first aid provider should be confident and skillful in assessing the victim
and resuscitating the victim as per the need. In the next unit, we will
discuss the use of AED in resuscitation of the victim.

7.6 KEY WORDS

Compressing : Pressing down with pressure

Repeated : Doing in a manner which occurs one after the

another

Coordination : In a harmonious manner or working with one another

Ensure : Making sure

Gasping : Shortness or difficulty to take breaths

Alert : Fully aware and attentive

Advanced : Modern and well developed, better qualified

Blind : Inappropriate, Not proper

Sweep : Clean out

Technique : Method or skill

Recommended : Suggested

Recoil : Rebound or spring back through force of impact or

elasticity

Enough : Adequate/Sufficient as per requirement

Forceful : With force or effort

Seal : Close securely

Patent : Open and unobstructed

Concentration : Amount of a particular substance contained within a

solution

Relaxed : Free from tension

Flabby : Soft, loose, not firm

Obstruct : Block or Prevent movement

Secretions : Discharge from body tissues

Fluids : A substance which flows easily e.g. water

Switch over : Change

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Practical Manual-I
7.7 ANSWERS TO CHECK YOUR PROGRESS
Check Your Progress 1

1. a. False b. True c. True d. True e. True

Check Your Progress 2

1. Recovery position is the position which helps to maintain breathing in

a non responsive but breathing victim.

2. Recovery position is indicated for non responsive and breathing victim

for prevention of choking which occurs due to tongue of the victim
which falls back in the airways due to loss of tone or due to
secretions/fluids and blood collected in the oral cavity.

7.8 ACTIVITIES
Activity 1

Enact a role play wherein a person is lying and you have been called to
provide emergency care. Assess the victim for giving CPR following the
steps described in the unit. Record in Log-Book.
(Self Activity)

Activity 2

Perform CPR step by step on the manikin provided. Record in Log-Book.

(Supervised Activity)

Activity 3

Practice Recovery Position on your peers. Record in Log-Book.

(Supervised Activity)

Activity 4

Practice Recovery Position in Self study group. Record in Log-Book and

paste a picture of your work.
(Self Activity)

7.9 REFERENCES
1. http://www.redcross.org/images/MEDIA_CustomProductCatalog/
m55540601_FA-CPR-AED-Part-Manual.pdf

2. http://cpr.heart.org/AHAECC/CPRAndECC/ResuscitationScience/
Guidelines/UCM_473201_Guidelines.jsp

3. http://wwlp.com/2017/08/02/american-heart-association-releases-new-cpr-
guidelines/

4. http://www.heart.org/HEARTORG/CPRAndECC/
CPR_UCM_001118_SubHomePage.jsp#.WYwu5NIjG1s

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5. https://www.aclsmedicaltraining.com/one-rescuer-bls-cpr/
6. https://acls-algorithms.com/2016-acls-guidelines/bls-and-cpr-quality- Cardio Pulmonary
changes/ Resuscitation (CPR) and
Recovery Position
7. http://www.heartacademy.org/phpwcms/index.php?Vol9No4_Page13

8. https://clinicalgate.com/life-threatening-emergencies-rescue-
breathingcprchoking/

9. http://hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/
2011/03/CPR-compressions1.jpg
10. https://commons.wikimedia.org/wiki/File:2002_CPR_Technique.jpg
11. https://www.mybwmc.org/library/3/100219
12. http://www.sja.org.uk/sja/first-aid-advice/loss-of-responsiveness/
unresponsive-not-breathing/adult.aspx
13. https://image.slidesharecdn.com/pptcpr-140318065623-phpapp01/95/
pediatric-cpr-5-638.jpg?cb=1395126074
14. http://www.hopkinsmedicine.org/news/media/releases/
cpr_without_mouth_to_mouth_rescue_breathing_may_
be_better_for_many_victims_of_cardiac_arrest
15. http://www.webmd.com/heart-disease/heart-failure/news/20100728/
studies-cpr-without-rescue-breathing-ok#1
16. https://commons.wikimedia.org/wiki/
File:CPR_Adult_Chest_Compression_Sternum.png
17. https://physicalsportsfirstaid.files.wordpress.com/2014/09/recovery-
position-instructions.jpg
18. https://www.healthnavigator.org.nz/healthy-living/first-aid/recovery-position/

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